More people are getting tummy tucks and other so-called body-contouring procedures after losing a large amount of weight. While vanity may play a role in the decision to have such a surgery, new research shows that there are significant health benefits to these operations, including motivating patients to keep their weight in check.
Tummy tucks, officially known as abdominoplasty, aren’t typically covered by insurance. But they have become more common following bariatric surgery, which reduces the size of the stomach to help patients reduce food intake and lose weight. And unlike in the past, some surgeons are often more willing to perform the procedures in tandem with other types of abdominal surgery, as recent studies show there aren’t generally major complications from combining the procedures.
A study in the October issue of Plastic and Reconstructive Surgery by Swiss researchers found that bariatric patients who have surgery to remove excess skin are more likely to keep weight off after procedures, regaining an average of just over 1 pound a year compared with 4 pounds annually for bariatric patients who didn’t have contouring procedures.
The authors say the findings add to the argument that such procedures are an essential part of successful weight-loss surgery and should be considered reconstructive and thus covered by insurance.
These surgeries can produce “a second wave of elation” that helps a patient stay on track to lose more weight, says Tripp Holton, assistant professor of plastic surgery at the University of Maryland School of Medicine.
Many people who finally reach a goal of losing 50 or 100 pounds or more through diet and exercise or bariatric surgery find themselves with a new and frustrating dilemma: sagging extra skin and stubborn deposits of belly fat.
Lizanne Haddadin of Discovery Bay, Calif., lost 120 pounds over about eight years by watching her calories and regular workouts. When she had hernia surgery in July, Ms. Haddadin, a special-education teacher’s aide and mother of two, opted to have a tummy tuck at the same time to remove excess skin and fat she couldn’t shed after the weight loss and to tighten her abdominal muscles.
After her dual surgery, she came home with a pump to deliver pain medicine directly to the stomach area for five days, and had a licensed vocational nurse stay with her for 24 hours to help with bandages and drains. She says she was able to get by with minimal use of pain medication, and she took antibiotics to prevent infection, with no complications.
Ms. Haddadin, 46, was walking slowly on her treadmill a couple of weeks after surgery and is now jogging, hiking, swimming, weight lifting and taking exercise classes.
“I feel like clothes fit me better and I feel much better when I jog and exercise,” she says. “I was really uncomfortable having all that extra skin.”
Since the surgery, Ms. Haddadin, who is 5-foot-6, has lost an additional 15 pounds and is down to 176 pounds. Her eventual goal is 135 pounds. “I have a ways to go, but this has helped me get closer to my goal,” she says.
Ms. Haddadin says she felt the dual surgery was also cost-effective: Alameda, Calif.-based Rex Moulton-Barrett, the plastic surgeon who performed her surgery, included the hernia repair in his fee for the tummy tuck. The total cost, including surgery, anesthesia, the nurse and rental of a hospital bed for her home for 30 days, was about $8,000.
A study of 20 of Dr. Moulton-Barrett’s patients, published in the February issue of Plastic and Reconstructive Surgery, found that tummy tucks led to significant and lasting weight loss for many patients, especially those who were overweight and obese. Long-term weight loss was more likely for women in the study who were just under the borderline for overweight. And sustained weight loss was also more likely for those who had a greater amount of excess abdominal tissue removed.
Dr. Moulton-Barrett says increased satiety seemed to be an important contributor. And the study provides preliminary evidence that removing fat cells in the abdomen may lead to reduced levels of appetite-affecting hormones, which are secreted by fatty tissues, he says.
This was Ms. Haddadin’s experience. She says she gets less hungry and feels fuller sooner at meal times.
Like many surgical procedures, tummy tucks carry risks including infection and blood clots. But a study at Montefiore Medical Center in Bronx, N.Y., presented last April at the American Association of Plastic Surgeons’ annual meeting, found there was no evidence of an increase of complications among obese or even morbidly obese patients who had abdominoplasty 12 to 18 months after gastric-bypass procedures. The researchers noted that many such patients benefit from body-contouring surgery to improve daily-life activities.
After the Fat
These body-contouring procedures reduce fat or skin left behind after weight loss.
- Tummy tuck: removes excess fat and skin in the abdomen
- Panniculectomy: eliminates the ‘apron’ of sagging skin below the belly button
- Lower-body lift: removes the ‘belt’ of excess skin and fat from thighs, buttocks, hips and waist
- Arm lift: diminishes upper-arm area skin and fat, alone or with liposuction
- Face/neck lift: removes loose skin and jowls around the face and neck
- Medial-thigh lift: lifts and tightens sagging skin of the inner thigh
Source: The American Society for Aesthetic Plastic Surgery
While some surgeons avoid performing tummy tucks in tandem with other abdominal surgeries, citing evidence of higher complications, University of Maryland’s Dr. Holton says he performs contouring procedures with hysterectomies and for obese, diabetic patients having kidney transplants. Removing extra skin and fat in the abdomen can lessen the risk of infections that frequently occur in the folds of excess skin. It can also improve healing after surgery, he says.
“Combining surgeries is very reasonable. And when done safely it is a good strategy to avoid exposing patients to two separate episodes of general anesthesia—and to decrease the chance of wound infection,” Dr. Holton says.
He has sometimes contacted a health insurer, he says, to argue that procedures to remove excess skin are medically necessary in those patients.
In some cases, plans will pay for a separate procedure called a panniculectomy, which can be performed alone or in combination with a tummy tuck. It removes the pannus—an “apron” of skin and tissue from below the belly button that can hang as low as the knees, can’t fit comfortably into clothing and can cause back pain and serious skin issues, including infections and ulcers.
A typical tummy-tuck procedure removes two to 10 pounds of belly fat by disconnecting the skin from underlying tissues, tightening the abdominal muscles with sutures and trimming away excess skin.
In some cases, doctors remove fat deposits using liposuction, and remove excess skin and fat in the sides or back with an additional body-lifting procedure.
Since 2000, the number of tummy-tuck procedures has risen by 70% to more than 106,000, according to the American Society of Plastic Surgeons.
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